Binkhorst Lecture focuses on improving safety, efficacy in phaco

April 17 - Washington, DC - Cataract surgery has improved in terms of safety and efficacy with the introduction of phacoemulsification, foldable IOLs, and the use of smaller incisions. With a better understanding of fluidics - infusion and aspiration - phacoemulsification will continue to be refined.

Graham D. Barrett, MD, who delivered the Binkhorst Lecture during the opening session of the American Society of Cataract and Refractive Surgery annual meeting, explained that he became interested in the underlying mechanisms of phacoemulsification, which improved safety and efficacy, and therefore focused on this aspect of cataract surgery for this year's lecture.

In the 1980s, when he began practicing cataract surgery, the recommended incision size was 3.2 mm, which could lead to wound leakage, impaired chamber stability, and an increased the risk of rupture of the posterior chamber.

"This experience lead me to an appreciation of the important role of fluid infusion, phaco needles, pump systems, surgical technique, and aspiration tubing in achieving a balance between aspiration and infusion, which is fundamental in improving safety and efficacy in phacoemulsification," said Dr. Barrett, a consultant ophthalmologist in private practice, Lions Eye Institute, and head, department of ophthalmology, Sir Charles Gairdner Hospital, Nedlands, Western Australia.

He has developed various instruments to aid the cataract surgeon, including a new phaco needle that allows for a 2.6-mm wound with improved infusion, which reduces the chance of wound burn. He also designed an I/A cannula to help remove cortical material. The device, he explained, has a greater cross-sectional area, which improves the infusional fluid and also reduces surge during aspiration of cortical material.

Dr. Barrett noted that although improved technology has been critical in patient outcomes, surgeon techniques are also important in the drive for safety and efficacy. He covered ways to subdivide the nucleus as well as modifying aspiration tubing to prevent surge. He developed flow adaptive tubing to allow for higher vacuum levels and decreased risk of surge.

He also described some prototypes of instruments to be used in micro-incision cataract surgery. They included a coaxial irrigating device with sleeve diameter of 1.2 mm, a solid core needle with a titanium sleeve (able to deliver ultrasonic energy at the tip), and a solid core needle with a hollow tip and a plastic sleeve.